Alcohol dependence is common in general medical settings. While controlled clinical trials have demonstrated the effectiveness of brief advice from medical providers in decreasing consumption for non-dependent heavy drinkers, there is no evidence for effective treatments for alcohol dependence in this setting. This application proposes a five-year period of support for the candidate, providing him with sufficient time and resources to develop as an independent researcher conducting trials of treatments for alcohol dependence in general medical settings. The candidate is currently an Assistant Professor of Medicine at the University at Buffalo, State University of New York. His research background has focused on alcohol-related medical issues, and he has performed several epidemiologic analyses in this area. The career award will allow him to develop additional skills in health-related behavior modification, the use of diagnostic and measurement instruments commonly used in studies evaluating alcohol use and alcoholism, and in conducting trials of treatments for alcohol dependence within a general medical model. Such treatments will be aimed at complementing or providing alternative treatment options to more established standards of care such as referral to self-help groups or addiction specialists. A variety of formal and informal didactics during the early portion of the career development period are planned to facilitate completion of the research objectives. However the majority of the award period will be devoted to the supervised completion of a pilot trial. This trial will evaluate a primary care treatment model for alcohol dependence that includes brief, patient-centered, motivational counseling with optional naltrexone. This will be compared with a traditional medical model based on assessment and expert advice, and also including optional naltrexone. Outcomes will include various measures of medication use, alcohol consumption, and drinking-related adverse consequences. Activities during the award period will be supervised by senior research scientists from the Research Institute on Addictions and and the Department of Social and Preventive Medicine at the University at Buffalo, who have agreed to mentor the candidate over the five-year period.